Can't sumbit a report ticket

I can’t play the Call of Duty beta. When trying to contact support the submit button is not lit up and I can’t click it. I attached a screen shot and filled out all the text boxes, not really sure what I’m doing wrong.

Why are you trying to play COD? Fck blizzard, delete your account.

Support ticket repeatedly times out despite me testing my internet and seeing high speeds. Blizzard needs to resolve this issue.